Aortic Valvotomy for Aortic Stenosis : The Clinical Assessment

Summary A clinical study of fifty consecutive cases of aortic stenosis has been made with the object of assessing their suitability for aortic valvotomy. It is pointed out that severe symptoms develop late in the disease, and that at this stage operation may be an extremely hazardous procedure. Symptoms of severe effort dyspnœa, paroxysmal dyspnœa, angina pectoris and sometimes effort syncope are of grave prognostic significance irrespective of the patient's age. Early symptoms of moderate exertional dyspnoœ, fatigue and consciousness of the heart's action in a patient with aortic stenosis should not be regarded too lightly. They should draw attention to the necessity for more careful study of the case by other methods, so that the need for operation or otherwise can be assessed at an early stage. It is stressed that clinical and electrocardiographic signs often precede these symptoms and allow of early assessment. The pulse wave, assessed clinically and if necessary from an arterial pulse trace, is of important prognostic significance. A pulse pressure of 40 millimetres or below suggests severe aortic stenosis. Auscultatory signs are important in diagnosis but not so much in prognosis. The importance of careful radiological study of each case is emphasized. The presence or absence of calcium in the valve and the degree of calcification are fundamental considerations in diagnosis and in the decision on surgical methods of treatment. The presence and degree of left ventricular hypertrophy in the electrocardiogram is a vital consideration in all cases. Hæmodynamic studies with calculation of the systolic gradient across the valve and technical assessment of the degree of aortic incompetence are mentioned as being of value in doubtful cases.